Obamacare: Are the Libertarian Oppositions to the SCOTUS decision warranted?

By now, nearly everyone with access to this blog knows that SCOTUS has upheld the Obamacare bill. This has caused an uproar with Libertarian folks as well as those who might not call themselves Libertarians but who think gov’t telling them what they must buy is inappropriate. I’ll be discussing the objections levied by the libertarian minded objectors, ultimately concluding that some of the Libertarian concerns are warranted while others are just malformed. Though I disagree with many of their fundamental arguments I’ll argue in unison with them that the ruling is wrong-headed and I’ll offer what should have been done instead. My recommendation will not sit well with Libertarian minded folk but I do think it’s consistent with my stand against the SCOTUS ruling on the Obamacare bill more generally.

Propaganda images like this are littering the social networking sphere.

There have been lots of objections levied against the SCOTUS ruling, here I’ll focus on 2 of the more popular objections given by the Libertarian folks and consider and reject some of the opposing arguments against them before offering my position that does not fall prey to the arguments I’ll be criticizing. So, I’ll first defend the Libertarian claims opposing Obamacare, then, I’ll argue for a proposal that Libertarians will oppose.

( Libertarian Objection 1) – We should be free to make our own choices regarding health care. If we want it we can pay for it, if we do not want it we should have the right to make that choice without paying a steep fine.

Some non-Libertarian objections: Libertarians are inconsistent! “American citizens are required by law to obey certain practices. Some of these practices include driving at a safe speed. The intention behind many of these mandates is to protect the well-being of the individual and other citizens of the state”. Similarly, the Obamacare ruling by SCOTUS is also in place to protect the well-being of both the individual and other citizens of the state. Thus, the libertarian is being inconsistent to oppose Obamacare but not speeding laws and the like.

(Possible Libertarian Response): When one is “mandated” to follow a speeding limit it’s right to think that it’s a mandate to protect fellow citizens, but that’s vague and a bit generic. If you think about it a bit further those laws are in place to protect citizens from other citizens, not just laws to protect citizens generally. No one should infringe on the rights of others, and, by having such a law or “mandate” this helps to ensure that such actions don’t take place. With the Obamacare mandate it is much more general, protecting citizens from EVERYTHING and not from other citizens per say (cases of catching a disease from another aside). So, one could accept the mandate of speeding limits but reject the mandate presented by obamacare on the grounds that the former is a limit imposed to protect each other in cases of negligence and infringement on our rights (by other citizens directly putting me in harm) while the latter is more of a paternalistic mandate that directly infringes on my right to make my own autonomous decision regarding if I want health insurance or not without being fined for making the decision not to. By choosing not to have health care I do not put any citizen (other than myself) DIRECTLY in harm’s way (again cases of disease aside) while in the case of speeding I do put others directly in harm’s way. If one wants to press the disease case then this opens up a paternalistic can of worms that I’d rather not focus on at the moment (for instance, eating habits, certain technologies, television programs, and commercials put others at risk as well. Would we mandate that people not be allowed to engage in such practices as well?). This Libertarian response seems spot on!

(Libertarian Objection 2) – Gov’t forcing me to buy health insurance from a private corporation is adding to the health care infrastructure problems and not fixing them. By putting more money into the hands of the greedy health insurance companies we are enabling them to continue to trend of unaffordable (good care).

(A non-Libertarian response) Health care for ALL in a messed up system is better than health care for SOME in a messed up system.

(Possible Libertarian Response) – ” if you can’t afford insurance when they don’t compel you, why will it be more affordable if they _do_ compel you?”

This response seems right to me! The reason that many do not have coverage at the moment is because they simply cannot afford it. But, one will be forced to buy insurance or pay a steep penalty. The SCOTUS decision on Obamacare seems to put money into the hands of the greedy corporations and out of the hands of people already living paycheck to paycheck. Granted, these people will have coverage now, but maybe they won’t be able to afford the car that gets them to and from work each day. This ought to be quite concerning to all.

My Take (A Philosopher’s Take – cheesy, but couldn’t help myself)

I won’t comment directly on the constitutionality of the SCOTUS decision, that’s a bit more complicated, rather, in this short rant I’ll focus on Obamacare and the problems I have with being mandated to buy coverage or else face a steep financial penalty.

Obamacare takes a severe problem — a broken, deadly and terribly inefficient health care system (grossly expensive, drops patients who are sick, doesn’t cover many obvious ailments that ought to be covered, etc.) and imposes a non-solution to almost all of the problems that the system currently presents. So, we get mild to moderate reforms in exchange for “a virtually permanent enshrinement of that deadly, broken system. The mandate requires individuals to purchase a mostly unreconstructed, defective product”. Bullshit!

This bill further cements the Insurance stranglehold on the federal government. If we thought we had a tough time with Health Insurance lobbyists before, well, who’s going to challenge the Insurance Lobby’s power now?

Romney will not have the answers, but, he’s right that Obamacare isn’t the answer either.

I’m also quite concerned with what this SCOTUS decision means for possible limitless expansions of state power. There is nothing in this post that couldn’t be justified by the same reasoning the court used today. A few years ago “banning large sodas” would have been dismissed as a paranoid slippery slope, now look. Enjoy your popcorn next time you go to a film; it could be your last!

POSSIBLE EXPANSIONS OF GOV’T POWER AFTER SCOTUS (taken from a social networking post)Federal Broccoli Act of 2013: Eat your broccoli, else pay the IRS $1,000.

Federal Population Growth Act of 2020: Don’t exceed two children per couple, else pay the IRS $8,000.

I hope these bills seem as ridiculous to you as they do to me! All would be justified under the current ruling, chew on that.

“Much of the left is celebrating a law that forces Americans to buy the product of private profit-seeking companies, and ones that the same folks on the left so often vilify. This is corporatism/cronyism/rent-seeking at its worst and those applauding it have little ground to stand on when complaining about the continued influence that corporate America has on the political process. You are cheering on the biggest green light ever to expand it: let’s get Congress to force people to buy other stuff now. The politicization of profit and loss is what brought us the crisis and recession, but apparently that’s forgotten. And why this is any different from the subsidies doled out to the hated oil companies, I’d be curious to know.” Prof. Aeon Skoble

The above mentioned possible bills are very concerning and this is good reason to think that the SCOTUS decision may have been wrong. Aeon Skoble’s comments are spot on as well.

My suggestion: Rather than an extra tax (many who will get taxed are lower/middle class people) as suggested by the Obama bill, they should cut some line items from the military budget and give us all health coverage with the money we are already supplying to them. Currently, over 52% of our annual federal budget is given to the military to promote wars that most tax paying Americans disagree with. If we slashed that budget in half (or more) we could provide a Gov’t health care system alternative. This could (and likely would) lower the prices in the public sector and would not add to the tax for the lower/middle class as the Obamacare bill ultimately does.

The private sector is not getting the job done with regards to health care, we have too many that cannot afford it, that’s obvious. We currently provide essential services (like fire protection, police, foreign protection) and if the private sector is dropping the ball with health care our government should step in and attempt to alleviate some of the problems. However, we don’t accomplish this by giving those that cannot afford it an extra tax or mandate. We do that by providing a service with money we already have. We change the way the money is spent, not expand the gov’t to take more money from tax payers (primarily lower/middle class taxpayers). Yes, gov’t having their hand in health care will ultimately expand gov’t in one sense, however, it doesn’t necessarily mean that we must put more money in their hands. A reallocation of money the gov’t already takes will suffice to solve the problem of uninsured citizens. This suggestion will be opposed by Libertarians but I think it’s the right move.

I should mention that I lived in Massachusetts for 29 years. Everyone had care! This is needed to have a truly flourishing society (in my humble opinion). But, I reject the opinion that says we should add to an already swollen budget to provide it or tax those who truly cannot afford it. We have other means of accomplishing this goal and that should have been the route we should have taken. The Obamacare bill is bogus, it should be repealed and be replaced with a gov’t option. It won’t happen, but, that’s my take on it.

I like your solution. Rather than mandatory support for the private health care system, why not go to a single payer system? As you say, most of it could be accomplished with reallocation of funds rather than new sources of income. You can now dismiss my comment because I am a biased Canadian.

I have always thought that individual health decisions can and do cause direct harm to others. Indirectly, if some people are smokers and miss more time from work and have more frequent hospitalizations, we all pay for their care through higher insurance premiums, tougher sick leave rules at work, and so on. Directly, if I choose to go to work sick with H1N1, or I don’t vaccinate my children, I am putting other people at risk of harm. It is difficult to weigh these individual decisions against the public good.

I agree that health decisions can and do cause direct harm to others. But, a government shouldn’t be dictating what we can and can’t do. I’m not a fan of a dictatorship. Sure, it MIGHT be safer but what good is a safe life if I’m not the one making my own decisions about what I want to do. With regards to speeding, one slip up and others are dead, I can agree to speeding laws to restrict my ability to speed But, health decisions? Watching too much TV is bad for your eyes, that affects costs of eyecare, should we restrict it? Drinking too much juice is high in sugar, should gov’t restrict it? Gambling affects a families ability to save for the future, should we disallow people of lesser incomes to participate in it if they choose? How about amusement parks? They can be dangerous, should we stop people from going? Violent movies – studies have been shown that they cause aggressive behavior, get rid of them? Freedom is an important part of being autonomous and being autonomous is necessary in order to be responsible citizens. I worry about forcing people to do things, in this regard I’m sympathetic to the Libertarian ideal.

Thanks for reading, John. I studied under some pretty well established Libertarians, mostly those of the anarcho-capitalist stripe. I’m a recovering Libertarian myself. I never gave an exact account of what a Libertarian actually is in this post, I took that as a given,so I’m curious to hear why you think I misinterpret the Libertarian position. Granted, there are many varieties, but I think the Libertarian responses I gave (the ones with quotes were taken FROM Libertarian profs) fall under the Libertarian rubric.

I figured that you would disagree. After reading your post on health care I realized we have a difference in opinion. Many disagree with me, so, you have lots of company.🙂

Justin – nice post (even though it took me a while to find time to read it…). Two points about the Affordable Care Act (“Obamacare”) that you missed, and that are relevant to your argument. Let me start by saying that I agree with you on the public option. While a single payer system would greatly affect me (a US Pediatrician in private practice, for those who don’t know), I think it’s unethical to have a society where some of us have access to health care and others do not.

The points that I think you neglected (and that your libertarian friends ignore) is that the Individual Mandate lowers the cost of health insurance. If we are going to do away with the exclusion for pre-existing conditions, and thus stop denying insurance to those who most need it, we need an individual mandate. First of all, to spread the cost. If we are not going to have a single payer system we must find a way to share the cost of medical care. How do we do that? Simply by making people pay in even if they do not use the system. Just like auto insurance. (To keep this simple, let’s not pursue the line of argument that talks about why your auto insurance doesn’t pay for oil changes or a new fancy stereo). Many will never use their auto insurance coverage, yet pay it gladly so that if they get into an accident they will not be bankrupted or inconvenienced (financially or otherwise) by the need to pay for repairs or replace their car. Could we just ask everyone to simply set aside some money every month to pay for their own repairs, replacement, etc? Sure, but I think we all know it wouldn’t happen. The individual mandate is no different – just a way to spread the cost, spread the risk.

Does the government have the right to do this? Is it overstepping it’s bounds? No. Government is there to do things that are difficult or impossible to do on the individual level. It is also responsible for compelling us to do things that are societally desireable, like driving safely to avoid killing and injuring others. Yes, it’s forced consumption. Deal with it.

As to the arguments about the limits of government power – why not let science decide where the limits are? The “Broccoli Law” is a fun argument, but here’s the difference – there’s no evidence that NOT eating broccoli means you are not healthy or that NOT eating broccoli makes you a burden on society in any way. Not having health care, not getting immunized, not visiting the doctor when your diabetes is controllable rather than when you need a heart bypass or leg amputation – those things have societal costs.

To your libertarian friends, I will pose this “compromise.” We will not require you to purchase a product that you object to. But, if you are uninsured you will be responsible for your medical bills. (There are many who argue this is the way to ‘fix’ the health care system. To them, I say “bullshit,” but that’s a topic for another post.) To put it simply, when we as a society are ready to say to the 23 year old auto crash victim that they can get care in the ER only if they can pay, then we can take a pass on sharing the cost of health care. Until we’re ready to let people die because they can’t afford a visit to the doctor, a surgery, a medication, an ER visit then all discussions of individual choice are hollow, in my opinion. (Please note that I do not advocate this – I find it an abhorrent idea, but for the sake of argument…)

The second point that you neglected is that the law includes a provision that requires for-profit insurance companies to limit the amount of the premium dollar that they spend on “administration” and limits their profits. You have to spend some minimum percentage on actual medical care, and if you don’t hit that minimum, you have to return premium dollars to the subscribers. Not such a bad thing, in my opinion.

I’ll stop there, before my comments become longer than your original post. But you wrote about something that I’m passionate about – as a doctor, as an american, as an ethical person. I’m anxiously awaiting your responses…

Thanks for taking the time to read it, Nelson. I enjoy reading your perspective on things, especially when related to your work. Here is my brief response.

To your first point – you claim that “I’ve neglected the fact that hat the Individual Mandate lowers the cost of health insurance”. It doesn’t lower the cost of health insurance for those who cannot afford it in the first place, that’s important! Also, it lowers it for some, but it also gives them a lesser product in the end. I live in a country where everyone has coverage. The waits are longer and the care is not what it was in the states. Should people not receive care so others can get more effective/efficient care? No, I’m not saying that. But to say “people get cheaper care now” as if it’s a win-win is misleading. So, yes, all will have coverage now, but, some(lots) will be forced to give money they do not have (those Americans already living paycheck to paycheck that are “technically” not considered poverty by the gov’t). I agree that it is unethical to live in a society where some of us have coverage and others do not, but, to say that it is a political right is another matter. Because, if it is, as my former prof pointed out in a recent thread on this issue, if “Basic healthcare is a right, a political right due to each and every person can doctors and nurses be compelled to work for free? We run into problems when we call it a right. Again, I agree that it is unethical, but, to force people to pay for something they do not want seems unethical as well, especially when we are taxed 30% of our pay already. That money should suffice to offer coverage to all. That’s the answer not taking more of our money (in my humble opinion).

I agree that people should not be turned away because of pre-existing conditions, but, I don’t think a way around that NEEDS to be a mandate of some sort. The answer lies with the money the government already has. As I suggested in my post, I think that can be had by slashing the military budget, but that’s a different sort of discussion, sorry for the digression, now back to your response.

You said “If we are not going to have a single payer system we must find a way to share the cost of medical care. How do we do that? Simply by making people pay in even if they do not use the system.”

Sure, that’s one way to do it, but that’s unjust. A better alternative would be to limit the industries ability to maximize profits the way that they do. So, a bill that said “you cannot turn away ANYONE, or, you must provide a plan to everyone and that it should be based on how much they make”, or something along those lines. Now, the libs will say that this is also unjust, however, I have a much more difficult time buying the injustice that medical insurance companies (some of the most economically successful corporations in the WORLD) will inherit by forcing them to provide coverage (or by regulating their profits) when compared to making those living paycheck to paycheck pay a penalty or by telling the taxpayers that supply the government with trillions already that we must give fat-cat corporations more money even if we don’t want their product.

You also said “Does the government have the right to do this? Is it overstepping it’s bounds? No. Government is there to do things that are difficult or impossible to do on the individual level. It is also responsible for compelling us to do things that are societally desireable, like driving safely to avoid killing and injuring others. Yes, it’s forced consumption. Deal with it.”

This sounds a lot like a dictatorship, doesn’t it? Let government tell me what to do, they have science backing them. Hitler said the same things about eugenics to justify his behaviors. I only bring him up to show how such justification can go astray. Having people with disabilities has a societal cost, should we rid the world of them? Obviously not! Compelling us to do things that are “societally desirable”? That gets really, tricky. Societally desirable by whose measures? Society at large? Well, that can’t be it, most of society, at least historically, has been racist, should we segregate if that’s what “society” wants? Or, are you projecting the “ideal society”? If so, should it be your ideal society or mine? You see the problem?

Also, the broccoli law might be dis-analogous, but, a law banning smoking, liquor, the telephone (there has been some research that shows that ones cancer rates go up when using the phone for extended periods of time), foods high in saturated fat, vehicles, etc would follow because those that engage in such acts does/can make you a burden on society in one way or another. Would you say to them “Yes, it’s forced consumption (or limiting your ability to consume), so deal with it? This smelIs quite anti-american to me and far too paternalistic. I have much more to say here (we can discuss further if you’d like), however, this response is getting far too long as it is.

You said, and admittedly I failed to mention “You have to spend some minimum percentage on actual medical care, and if you don’t hit that minimum, you have to return premium dollars to the subscribers. Not such a bad thing, in my opinion.” I agree with you here, not a bad thing at all.

Lastly, you said “To put it simply, when we as a society are ready to say to the 23 year old auto crash victim that they can get care in the ER only if they can pay, then we can take a pass on sharing the cost of health care. Until we’re ready to let people die because they can’t afford a visit to the doctor, a surgery, a medication, an ER visit then all discussions of individual choice are hollow, in my opinion.”

This points to a problem with a for-profit medical system, not a problem regarding individual liberties. Why sacrifice liberties for a terrible system that lines the pockets of corporations who are pretty much running the country already? A friend put it best; “This entire “reform” takes a severe problem — a broken, deadly and grossly inefficient system — and imposes a non-solution: mild to moderate reforms in exchange for a virtually permanent enshrinement of that deadly, broken system. The mandate requires individuals to purchase a mostly unreconstructed, defective product. People who wanted genuine reform like this “health insurance reform” due to the mistaken belief that it is an incremental reform that gets us closer to a real solution. But instead, it further cements the Insurance (and the FIRE/Wall St. Lobby’s) stranglehold on the federal government.”

I think we need to give our citizens health care, but we can do it by supplying them with care with money they have already given to the federal government. Most Americans oppose the wars and conflicts that we are involved in, the defense budget consumes 52% of the entire federal budget, this could cover those without, and could cover those who want to opt out of their over-priced policies. This would force greedy health insurance companies to provide affordable alternatives and a better product or be put out of business. I’m with you, we need to get coverage to all, but by accepting this bill we allow corporations to have a stranglehold on the American Government and in turn on the American people.

Thanks again for reading and commenting, Nelson. I look forward to talking more about this with you in the near future. Sorry for the length and the moments of incoherence, I didn’t have time to proofread or read over what’s here (infants take up lots of time🙂 )

What is it exactly that makes people sick nowadays? Artificial food, apathy, unknown gov’t/corporate experiments, lack of education, pollution, bad water, stress, over-consumption, little to no exercise, pharmaceuticals? Seems there’s quite a bit more we could do about the whole healthcare issue than simply adding another band-aid, or depending on another greedy individual or corporation to “heal” us.

Justin,
I like most of your solutions .. they make sense.. the only thing that worries me is taking money away from the military. I spent 9 years in the ARNG and I have a lot of friends still in. Taking money away from the military does nothing to stop or slow wars. If the government wants those wars the government is going to get those wars whether they have the funds or not. Look at us now we are basically owned by China, we are in debt over our heads and yet we are still seeing our men and women sent overseas to a war that supposedly is being ended (when?). Although I agree that we need to slow our wars possibly bring them to an end safely… we cannot do that at the cost of more American lives and shoddy protective equipment because of budget cuts. I think, personally, if Obamacare is going to slip through and be passed ,regardless, it should be up to each state individually to decide if they want it or not. That way if someone doesn’t like it they can move to a state that doesn’t have it and if someone does want it they can do likewise to a state that has it. That is my personal opinion although I know for sure that there are definite faults with that. Nothing, no solution, is ever going to be perfect but I can definitely agree with you that Obamacare is NOT a good choice. It will just make this situation that we are in that much worse.
-Amy K

I certainly prefer a single-payer health care system and now that I am a permanent resident of Canada this is what I am enjoying. I don’t have a problem paying for it through consumption taxes either. Even though sales taxes are regressive, I don’t have a problem with them if they are exchanged for a program which everyone is able to enjoy regardless of income. I think a sales tax approach to funding universal health care is a wise one even though I well know it contributed to killing Mulroney and the Progressive-Conservatives in the federal election of 1993 (contributed but wasn’t the sole cause).

I agree with you that it would be ideal to provide people with care that they are already paying for with their taxes rather than introducing any additional taxes. I just don’t think that this will be accomplished through a debate on the federal budget. I don’t believe that there are enough pro-single payer voices in Congress to make this possible. The progressive caucus among the Democrats is a minority within a (current) minority. I don’t see Democrats from districts or states with large military bases or enjoying substantial defense contracts supporting spending cuts to the military and I also don’t see the so-called “Budget Hawks” on the Democratic side going for it either since they traditionally are strongly pro-Pentagon (especially those in the Border States and the mountain west). And it is going to be the Democrats not the GOP who pushes initiatives favoring a universalized program (I imagine we can agree on that).

I am not a libertarian or a conservative so I am inclined to be more sypmathetic to the general intentions of the Affordable Care Act. But I agree, I don’t think that this program gets to the root issue which is that the American healthcare system is a for-profit system dominated by the health insurance industry and big pharma. The power of lobbyists and corporate money is immense in Washington and I think (call me Polyanna if you like) President Obama knew and knows this and that he pushed the Affordable Care Act because he thought this was the best possible bill that he could get through Congress. I am not being partisan about this, I am just recalling what I saw and read during the Congressional debate and since the act was passed. Personally, I can’t take seriously the Republican opposition (I’ll leave libertarians out of this) because they don’t offer any plausible alternative as you’ve noted.

By the way, I am enjoying your blog and your thoughtful and engaging posts. I am happy to have found this and look forward to much good reading.